Cases Of Uterine Sarcoma Research Articles

Sarcome utérin survenant au cours d’une hormonothérapie par tamoxifène. À propos de deux cas

Introduction. – Tamoxifen - a non steroidal triphenylethyl compound – in addition to having antiestrogenic properties may provoke weak estrogenic effects, the well known “paradoxical effects’’ on the female genital tractus. Concern has been raised about prolonged tamoxifen treatment and subsequent occurrence of endometrial adenocarcinoma; subsequent attention has been drawn through high risk histologic subtypes including poorly differentiated patterns and uterine sarcomas. Exegesis. – We report two cases of uterine sarcoma arising in postmenopausal women taking tamoxifen, 20 mg daily during 38 and 42 months, for breast carcinoma: one leiomyosarcoma and one endometrial stromal sarcoma; both cases were asymptomatic and detected by pelvic sonography. Conclusion. – Further studies will be required to establish if there is a relationship between long term tamoxifen exposure and highly aggressive types of cancer of the uterine corpus exhibiting adverse histologic features such as uterine sarcomas. There is no consensus regarding uterine surveillance of women receiving tamoxifen. We advocate an annual gynecologic examination plus imaging by means of transvaginal ultrasonography.

A Clinical Study of 20 Uterine Sarcomas

Sarcoma of the uterus is very rare malignant tumor originating from uterine muscle or connective tissue. We have experienced 20 cases of uterine sarcoma from January 1991 to June 1998. The results were as follows: 1. The pathologic types were 13 cases(65.0%) of leiomyosarcoma, 5 cases(25.0%) of malignant mixed Mullerian tumor, 1 case of rhabdomyosarcoma, and 1 case of angiosarcoma. 2. The average age and parity was 50.2 and 3.7. The chief complaints were irregular vaginal bleeding(35.0%), lower abdominal pain(25.0%), and abdominal mass(25.0%). 3. Nine cases(45.0%) were FIGO stage I, 1 case(5.0%) was stage II, 6 cases(30.0%) were stage III, and 4 cases(20.0%) were stage IV. 4. The survival was from 1.5 months to over 130 months(median 16.5 months), and there was no correlation between survival and FIGO stage or pathologic type. The correlation between survival and number of mitotic figure was incalcurable. 5. CA 125 levels were serially measured as a tumor marker in monitoring patients and the positive rate was 40%. Further study was needed to make a conclusion for usefulness of CA 125 as a tumor marker.

Uterine Sarcoma: A Report of 10 Cases Studied by Transvaginal Color and Pulsed Doppler Sonography

Objective: To evaluate the role of transvaginal color Doppler in differentiating uterine sarcoma from myoma. Study design: A group of 2010 women were examined by transvaginal color Doppler ultrasonography 1 day before planned hysterectomy. Ten cases with uterine sarcoma were analyzed with respect to their color Doppler sonographic patterns and compared with 150 normal and 1850 myomatous uteri. Analysis of variance was used to test the significance among the subgroups. Results: All cases of uterine sarcoma (100%) revealed abnormal tumoral blood vessels. The mean resistance index (RI) of these vessels was 0.37 ± 0.03, ranging from 0.32 to 0.42, which is statistically significantly lower than that of the normal and myomatous (P< 0.001) uteri. There was no significant difference between RI in the right and left uterine arteries in each separate group; however, there was a decline in these values from normal, through myomatous, to sarcomatous uteri. Using a cutoff point of 0.40 for RI we were able to distinguish between benign and malignant myometrial tumors with a sensitivity of 90.91%, specificity of 99.82%, positive predictive value of 71.43%, and negative predictive value of 99.96%. Conclusion: Color Doppler sonography has the potential to distinguish uterine sarcoma from benign uterine lesions.

Uterine Stromal Sarcoma Diagnosed During Treatment with Gonadotropin-Releasing Hormone Agonist During Therapy for Presumed Leiomyoma

Uterine leiomyomas are common tumors of the female genital tract. Management of these tumors may include treatment with gonadotropin-releasing hormone agonist (GnRH-a). We present a case of a woman treated with GnRH-a for presumed uterine leiomyoma, who subsequently was found to have an endometrial stromal sarcoma. Six previously reported cases of uterine sarcomas treated as presumed leiomyomas with GnRH-a are reviewed. Clinical features that might identify women with malignancy are discussed. (J GYNECOL SURG 11:99, 1995)

Gynecologic tumors in tamoxifen-treated women with breast cancer

To present six additional cases of gynecologic tumors in tamoxifen-treated breast cancer patients, review the literature, and recommend measures for surveillance.The hospital and office records of patients treated with tamoxifen at the University of Kansas Medical Center and Research Medical Center were analyzed. A comprehensive review of tamoxifen in the English and European literature was performed using MEDLINE and the bibliographies of various articles.From 1985-1992 at our institutions, six tamoxifen-treated breast cancer patients developed gynecologic tumors: three endometrial adenocarcinomas, a mixed müllerian sarcoma, a fallopian tube carcinoma with adenofibroma of the endometrium, and recurrent hyperplastic endometrial polyps. The literature contained 61 cases of adenocarcinoma of the endometrium and possibly four cases of uterine sarcomas in tamoxifen-treated breast cancer patients. The number of gynecologic malignancies reported is now 70. In 35 of the patients, the mean age (+/- standard deviation) was 63.9 +/- 12.0 years, and 61 of 66 patients (92.4%) were postmenopausal. Of the endometrial adenocarcinomas, 25 of 27 (92.6%) were stage I, and 11 of 27 (40.7%) were grade 1. The dose of tamoxifen was 20 mg/day in 15 (23.4%), 30 mg/day in 11 (17.2%), and 40 mg or higher in 38 (59.4%); 57% were treated with tamoxifen for less than 2 years.Tamoxifen is a safe and reliable treatment of breast cancer, but data suggest an association with endometrial cancer. We propose close monitoring of patients taking tamoxifen and prompt evaluation of any uterine bleeding or pelvic complaint.

Leiomyosarcomas have a poorer prognosis than mixed mesodermal tumors when adjusting for known prognostic factors: The result of a retrospective study of 423 cases of uterine sarcoma

Leiomyosarcomas have a poorer prognosis than mixed mesodermal tumors when adjusting for known prognostic factors: The result of a retrospective study of 423 cases of uterine sarcoma

Clinical experiences with 140 cases of uterine sarcomas

Clinical experiences with 140 cases of uterine sarcomas

Retrospective analysis of 318 cases of uterine sarcoma—Response

Retrospective analysis of 318 cases of uterine sarcoma—Response

Retrospective analysis of 318 cases of uterine sarcoma

A study of data from 318 cases of uterine sarcoma presenting during a 10-year period (1967–1976) is reported. All but 6 of the patients had at least a 5-year follow-up (98% 5-year follow-up). Overall 5-year survival was 31%, with the major prognostic indicator being tumour stage. Despite the tendency for mixed mesodermal tumours to present in older women with more advanced disease, survival was not statistically different to those patients with leiomyosarcomas. Thus, the propensity for tumour dissemination in leiomyosarcomas should not be underestimated. Leiomyosarcomas are less likely to present with abnormal symptoms than are other sarcomas, and their occurrence as an incidental finding on histological examination underlines the need for an adequate inspection of the intra-abdominal contents at hysterectomy. The tendency to treat all sarcomas as if they were endometrial tumours may be fallacious, and an alternative classification (such as the TNM system) may be required. Recurrence of tumour tended to be at distant sites (distant:pelvic recurrence rate 3:1). Adjuvant radiotherapy is unlikely to alter distant disease foci, and thus the development of combination chemotherapeutic regimens using agents which have shown to result in tumour response seem warranted. Such trials will need to be organised on a multicentre basis to attain statistically evaluable numbers of patients.

Reappraisal of uterine sarcoma diagnosis in the Swedish Cancer Registry

An investigation of over- and under-registration of uterine sarcomas in the Swedish Cancer Registry during the period 1958-1980 was carried out. A histopathologic review of a 10% sample (159 cases) revealed that 18% of the cases, the majority of which were benign leiomyomas, could not be reclassified as sarcomas. All 186 cases of uterine sarcoma treated at Radiumhemmet during the period 1958-1980 were found in the Cancer Registry, but only 90% as sarcomas. As a consequence of over- and under-registration of the sarcoma tumors, the estimated incidences will be affected. In this study, however, we could not find any time trend in the erroneous registration, which implies that comparisons in incidence over time would still be valid.

Uterine sarcoma with liposarcomatous differentiation: Report of a case and review of the literature

Heterologous sarcomas of the uterus are uncommon neoplasms. A liposarcoma in combination with a leiomyosarcoma of the uterus has been reported only once prior to this case report. We report a case of uterine sarcoma demonstrating two distinct variants of liposarcoma. This has not been seen to date.

Radiotherapy and/or Chemotherapy as Adjuvant Treatment of Uterine Sarcomas

Abstract A retrospective evaluation of 87 cases of uterine sarcoma treated during 1965–1980 at two Swedish hospitals has been made. Adjuvant postoperative radiotherapy has been compared with adjuvant chemotherapy. Various types of combination treatments were also evaluated. Both types of adjuvant therapy seem to reduce the failure rate, both locally in the pelvis and at distant sites, although survival, studied by the life table technique, was unaffected. Radiotherapy appears to reduce the number of pelvic failures when used as combination therapy and chemotherapy tends to prevent distant recurrences when used together with surgery. Further prospective and randomized studies are needed, however, to answer the question of the long-term value of adjuvant radiotherapy and/or chemotherapy in the treatment of uterine sarcomas.

Radiotherapy and/or chemotherapy as adjuvant treatment of uterine sarcomas

A retrospective evaluation of 87 cases of uterine sarcoma treated during 1965–1980 at two Swedish hospitals has been made. Adjuvant postoperative radiotherapy has been compared with adjuvant chemotherapy. Various types of combination treatments were also evaluated. Both types of adjuvant therapy seem to reduce the failure rate, both locally in the pelvis and at distant sites, although survival, studied by the life table technique, was unaffected. Radiotherapy appears to reduce the number of pelvic failures when used as combination therapy and chemotherapy tends to prevent distant recurrences when used together with surgery. Further prospective and randomized studies are needed, however, to answer the question of the long-term value of adjuvant radiotherapy and/or chemotherapy in the treatment of uterine sarcomas.

Analysis of 28 cases of uterine sarcomas : Rationale for Integrated Multimodality Treatment

Analysis of 28 cases of uterine sarcomas : Rationale for Integrated Multimodality Treatment

Sarcomas of the Uterus: Morphological Criteria and Clinical Course

Sixty-nine cases of uterine sarcoma were reviewed histologically with respect to their grade of malignancy. Mitotic activity is the most important criterion of malignancy. A histological grading was performed on the basis of mitotic counts per high power field. Clinical follow-up showed that except for the local extension of the tumor, the prognosis of sarcomas depends greatly on mitotic activity. There is a good correlation in the lower stages I and II between number of mitoses and survival rate. The 5 year survival rate of patients with grades I or II is 77% compared to 41% for grades III and IV. Vascular invasion is not evident in distant metastases in our material. Adjuvant chemotherapy is recommended in clinical stages II–IV and in histological grades III and IV.

Uterine sarcomas: natural history, treatment and prognosis.

Seventy-three documented cases of uterine sarcoma were treated at the University of Rochester Strong Memorial Hospital from 1955 to 1975. Thirty-three patients (45%) were treated with surgery only [S], 31 (43%) with surgery and radiation [S + R], and 9 (12%) with radiation alone [R]. A review of the literature with over 900 cases was also performed. Several important issues regarding these rare tumors are addressed, such as the prognosis of the several histologic variants, the role of radiation therapy in their management and what perhaps may constitute a comprehensive therapeutic approach. These tumors are characterized by local aggressiveness and early widespread dissemination. There are three main histologic varieties: mixed mesodermal sarcoma (MMS), leiomyosarcoma (LMS) and endometrial stromal sarcoma (ESS). Of the three, MMS was the most common, seen in 60% of the cases; LMS occurred in younger patients and tended to be localized to the uterine corpus (Stage I) in 80% of the instances. Tumor extent at diagnosis was the main prognosticator for survival in uterine sarcomas; patients with Stage I tumors had a significantly lower incidence of recurrences, as well as a better survival than patients with more advanced tumors. Stage-by-stage, there were no significant differences in survival among the pathologic variants. To ensure adequate staging, a surgical procedure is recommended first whenever possible. Adjuvant radiation therapy significantly improved disease controlability in the pelvis, although it may not have dramatically affected the final outcome. In addition to pelvic irradiation, some form of systemic therapy should be administered to decrease distant metastases.

Uterine sarcomas: analysis of failures with special emphasis on the use of adjuvant radiation therapy.

There were 47 failures among 73 verified cases of uterine sarcoma reported at the University of Rochester Tumor Registry from 1955 to 1975; they constitute the subject of this report. Of 33 patients initially treated with surgery only [S], 19 patients (58%) failed; 20 of 31 patients (65%) treated with surgery and radiation [S + R] failed; 8 of 9 patients (89%) treated by radiation alone [R] failed. According to pathology, failures occurred in 33 of 44 patients (75%) with mixed mesodermal sarcomas (MMS), 7 of 20 patients (35%) with leiomyosarcoma (LMS), 4 of 6 patients with endometrial stromal sarcomas (ESS), and 3 of 3 patients with other types of sarcoma. Once corrected by stage, there were no significant differences in failure rates, spread patterns or survival among these main histologic variants. Twenty of 41 patients (56%) with Stage I tumors failed with an average failure time of 32 months. Twenty-seven of 32 patients (84%) with Stages II, III, and IV tumor failed; their average failure time was only 9 months. The mean failure time for both the patients treated with [S] and [S + R] was 22 months; for patients treated by [R] it was 3 months. Isolated pelvic failures constituted only 4% of all failures, failures both in the pelvis and in distant sites, 49%, and distant metastases, 47%. There was a marked decrease in pelvic failures in patients treated with [S + R] when compared to those who received [S]. Adjuvant radiation proved to increase tumor control in the pelvis but did not influence the final outcome because over 90% of all failures developed distant spread outside the pelvis. The most common distant failures were in the upper abdomen (mainly omentum and peritoneum) and in the lungs. Lung metastases alone was the only site of failure in 16% of the instances. A comprehensive treatment approach based on the spread and failure patterns will be proposed.

Oestrogen Receptor Studies in Carcinoma of the Endometrium, Carcinoma of the Uterine Cervix and other Gynaecological Malignancies

The tissues from 30 cases of endometrial cancer and 44 cases of cervical cancer were examined for oestrogen receptor activity. Twenty of the endometrial and 9 of the cervical tumours contained oestrogen receptor levels above 4 fmol/mg protein. The proportion of oestrogen receptor-positive tumours was significantly greater in adenocarcinomas of the cervix than in squamous carcinomas of the cervix. Tissues from 3 mixed mesodermal tumours of the uterus, 2 carcinomas of the vagina, a carcinoma in situ of the cervix and a carcinoma in situ of the endometrium were receptor-negative. One ovarian carcinoma and a single case of uterine sarcoma were receptor-positive. The implications of these findings in relation to hormonal therapies are discussed.

Uterine sarcoma.

Thirty-four cases of uterine sarcoma were studied with regard to their pathologic characteristics and response to treatment. Pathologic features did not always correlate with subsequent course. Combined therapy seems to enhance two-year survival in endometrial stromal sarcoma (ESS), although some patients may have low-grade tumors and hence represent a more favorable group. Adjuvant irradiation may improve local control rates in some mixed mesodermal sarcomas (MMS), but does not add appreciably to survival. It is of doubtful benefit in the leiomyosarcoma (LMS) group. When irradiation is employed, preoperative therapy is preferred except in the highly malignant mixed mesodermal sarcomas where prompt surgery seems indicated first. Supplemental brachytherapy may also be employed.

Evaluation of 6,17α-dimethyl-6-dehydroprogesterone for treatment of recurrent and metastatic gynecologic malignancy

6,17 α -Dimethyl-6-dehydroprogesterone in large doses was evaluated as a therapeutic agent. In 61 cases of metastatic and recurrent carcinoma of the endometrium, there was a 21 per cent objective response; in 9 of metastatic and recurrent ovarian carcinoma, there was a 22 per cent objective response; and in 3 of metastatic and recurrent carcinoma of the cervix, there was no response. The drug also was used in conjunction with 5-fluorouracil or cyclophosphamide with no success in 7 cases of endometrial carcinoma and with limited success in 2 of 4 cases of uterine sarcoma. There were no significant toxic effects.